Northwest Medical Center has become the first hospital in Tucson to upgrade its technology for robotic-assisted surgery to the newest da Vinci Xi system, which means less time for surgical patients under anesthesia and vastly improved ergonomics for surgeons operating the robot.
The da Vinci Xi system allows for multi-quadrant surgeries where the instruments must be able to reach from the pelvis to the chest, compared to the previous da Vinci model, the Si, that might need to be repositioned during a procedure, depending on the type of surgery.
Kim Chimene, director of system marketing for Northwest Healthcare, said Northwest Medical Center has two da Vinci machines — the newest Xi and a Si unit — and that the hospital will evaluate the possibility of upgrading the Si machine in the future.
“Robotic surgeries don’t cost any more than other minimally-invasive surgeries,” Chimene said, “but they minimize the amount of time that patients are in the hospital, compared with traditional open surgeries.”
Chimene noted that many complex gynecological oncology and general surgery cases require either the patient or robot to be repositioned during surgery, which takes time. The new Xi robotic-system upgrade gives surgeons anatomical access from virtually any position, often eliminating the need for repositioning, she said.
“The ability to easily access different areas of the abdomen without having to reposition the equipment or the patient is very important when we’re performing gynecological cancer surgery on our patients,” said Hank Hallum, MD, a gynecological oncologist. “This new system provides us the flexibility to do that.”
Urologist Sanjay Ramakumar, MD, uses the robotic platform for prostatectomies and kidney surgeries.
Ramakumar pointed out, “The benefit of the new system will be for patients requiring surgery in multiple areas, for instance, the pelvis and abdomen, and difficult tumors. The surgery will be more efficient, resulting in shorter operative times.”
Ramakumar was part of the team that brought the first robotic da Vinci platform to Tucson in 2005 at the then-University Physicians Hospital Kino Campus.
“The da Vinci Xi makes laparoscopic surgery much easier for the surgeon,” he said. “Most of the upgrades have been in software and related to the cameras, as well as the ergonomic improvements made to the console. With the Xi, we have robotic arms that are truly versatile in that we can get anywhere in the chest or pelvis without repositioning.”
Sergio Gazic is a recent patient of Ramakumar who experienced a surgery using the da Vinci Xi robot.
“I did a lot of research after my diagnosis and got opinions from experts about robotic surgery,” Gazic said, “and everyone told me that robotic surgery was the best solution for my prostate cancer, especially with Dr. Ramakumar’s expertise and experience. I had the surgery done one day and was released from the hospital on the following day.”
Tori Fewell, MD, a gynecologist and surgeon at La Dea Women’s Health, uses the da Vinci to perform minimally invasive hysterectomies and to remove ovarian masses.
“The ease of maneuvering the robot and placing the ports has improved with the da Vinci Xi,” Fewell said. “The da Vinci gives you feedback if you’ve placed the ports too close together or are moving an arm out of the sweet spot. Now the robot is easier to use and it makes small corrections on its own. The robot has really changed gynecological surgery.”
The advantages for outpatients, Fewell pointed, are shorter hospital stays, less pain from the minimally invasive surgery, less time off from work, smaller incisions, fewer narcotics used and fewer recovery days overall.
Megan Nelson, MD, a general surgeon at Northwest Allied General Surgery, noted that any procedure that can be done laparoscopically can be done on a da Vinci robot.
“I’ve used it for gallbladder removal, colon surgery, hernia repairs and other surgeries,” Nelson said. “The da Vinci Xi is a game changer because it allows surgeons to operate in different quadrants during the same operation. With the prior robot, you had to decide where the incisions would be and select the robot position that was best. With the Xi, we have uncompromised technology that can roam over the body to where we need to be.”
She added, “With the Xi robotic system I see a three-dimensional view with 10 times the magnification of normal vision. This allows for a more controlled, precise operation. The new upgraded robotic equipment allows the surgeon access to the most difficult-to-reach areas of the body, such as deep in the pelvis. It truly acts as an extension of my own eyes and hands, but with greater range of motion and dexterity.”
Ramakumar noted that more innovations are in store for the da Vinci system.
“They are building single- port systems for the Xi platform,” he said. “When it is introduced we will be able to bring in four instruments through a single incision.”
Northwest Medical Center, a 300-bed hospital offering a full range of healthcare services including emergency services, is the second hospital in the state to receive the upgraded da Vinci Xi platform, Chimene said, but the first to use it because its surgeons already are trained on the equipment.